Archive for the ‘Dignity’ Category

I recently stumbled on an article by Professor Peter Beresford in The Guardian and his comments are worth sharing in this blog.

He is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives.

He notes that 70 years on from the creation of the welfare state, social care is one of the biggest, most important and yet most neglected social policies.

“Now another new government needs to face up to the vital need for radical reform,” he adds.

Indeed, that’s so true, but also frustrating. We meet up with Ministers(as we did Paul Burstow in London) and suddenly they are gone – taking with them all the good work we have shared. Such is the political arena.

Prof Beresford’s message is clear – social care reform must come from the grassroots

I quote: “The spending cuts made in the name of austerity over the last six years have especially hit local authority social care.

“This in turn has particularly hurt the growing numbers of older and disabled people needing help, including mental health service users and people with learning difficulties. While the rhetoric surrounding social care has been all about integration, the tendency is still to treat it in isolation.”

This is someone who has a good handle on the underlying issues of funding – the root of nearly all social care ills – and the frustration we feel in trying to get joined-up thinking between the NHS and residential and domiciliary care.

Based on research and interviews by the screenwriter Paul Laverty, this movie tells the fictional story of Daniel Blake, a middle-aged widower in the North East who can’t work or get benefits after a near-fatal heart attack.

The internet trailer is challenging and introduced for me a broader horizon of how ‘The Cuts’ – ‘Austerity Measures’ – call it what you will – have impacted our lives and how food banks have become ‘normal’ in an increasing desensitised society.

I find myself questioning: What is social care coming to? How has this been allowed to happen and what more can I do to help educate those who handle the finances of Government and seem unable to find funds for us.

Prof Beresford is the author of a new participatory social policy text, All Our Welfare, and he highlighted that there really are alternatives, both to old-style welfare state and current “neoliberal privatising welfare” reform.

Interesting – mental note; must find out more!

David Brindle, the Guardian’s public service editor who chaired an All Our Welfare launch debate, referred to the post-war welfare state as a revolution and asked what kind of revolution we need now.

On the panel, John McDonnell, shadow chancellor, emphasised the importance of developing a new narrative for a new welfare state, reminding us that its founders not only created a new architecture, but also “won the argument” so that for years Conservative governments continued to protect it.

“It’s narrative that wins,” he said.

Significantly, this was a different kind of debate because it included the groups more often talked about than having a chance to do the talking. Representatives of Disabled People Against Cuts, Shaping Our Lives, other disabled people’s and service user organisations, campaigners and user researchers, were present in force as well as the policymakers, academics and researchers more often encountered.

Is this the way we must go?

Summing up, the professor writes: “This was one occasion that demonstrated that there are very different ideas out there about a future for social care and welfare, which come from the bottom up. But they tend to be hidden or devalued and we need foster these green shoots. This is perhaps already beginning to happen. . . .

“For me, the key question posed by writing All Our Welfare was, how should people look after each other in a 21st century society? The launch debate showed that there are already many answers in the making – if they are only allowed space to surface.”

A landmark decision by GPs affecting their commitment to residential care homes and nursing homes is another crippling blow to the care sector. In this blog I want to look at the national scene and then post a second piece on the local picture.

Recently the BBC announced that the plight of care home residents “has pretty much slipped below the radar in recent years.”

It noted while there is “close scrutiny of everything from A&E waiting times to access to the latest cancer drugs, the support – or rather lack of it – care home residents receive from the NHS has gone almost unnoticed.”

I couldn’t have put it better myself.

Now for a few facts to set the scene of the latest bombshell to drop on the private care sector:

There are 16,500 care homes in England, looking after more than 300,000 residents

If nursing homes are included, the number of residents exceeds 400,000 (500,000 across the whole UK)

Nursing homes have to have a registered nurse on staff

Both care homes and nursing homes work with local GPs, hospital doctors and district nurses

Given the figures, it is obvious any major shift in the way NHS primary care is delivered into this clinically need-laden sector, would have major repercussions.

Announced by the Daily Mail on its front page, I discovered at the beginning of the month “GPs vote to axe care home visits”.

Up to 300 GPs’ representatives from powerful regional bodies voted at a crisis summit to end being responsible for care homes. Simply put: They want to ditch this responsibility.

The British Medical Association union may now lobby the Government to remove the responsibility of looking after residents from the GP contract.

The implications are huge to both service providers and users.

Historically, the care sector has had patchy service from GP practices.

In 2012 the Care Quality Commission reported 81 care homes looked at were not receiving regular visits from GPs. But now that frail commitment is going – or at least going in the way we have come to expect.

These patients are among the frailest, most vulnerable members of society. Many are living with a complex range of conditions, including dementia, heart disease and diabetes, with residents, according to the BBC, on an average of nine medications each.

Like many problems not given the media attention they deserve, the issue has been developing gradually over time.

What concerns me greatly is how quickly this news has dropped out of media interest. Anyone seen anything in the last couple of weeks?

It’s a ‘given’, isn’t it, that many of the people who decant into care and nursing homes are there because of clinical needs.

Doubtless, before that move, these people would probably have been among a GP’s most frequent visitors.

West Midlands Care Association has been flagging up the problem for years along with other representative bodies such as Care England and Age UK.

The bottom line, as with most problems in social care and the NHS, is money and the problem is two-fold, adding unbearable weight to care providers’ responsibility and costs and potentially subtracting essential care from our elderly.

I’ve seen reports of care homeowners paying GP retainer fees of £20,000 a year to provide regular doctor visits for residents. These figures are prohibitive to most providers within my region, but about a third of homes are in expensive surgery retainer agreements.

My fear is that again it’s our most vulnerable who get the worst of deals by default as our GPs push for the right to opt out of being responsible for frail, vulnerable and highly dependent people.

Issues like continuity of care immediately spring to mind and doubtless the cost of bringing in private providers will be loaded. But we have a legal responsibility to register every resident with a GP, and what’s more, my members want to care for their residents properly.

There’s a trend of moving seriously ill patients out of hospitals into care homes and nursing homes, what will happen to them?

Who are their advocates? Increasingly, it’s our care homes who are taking up their causes, but there must be a limit on just how much fighting we can do . . . Fighting to stay open, fighting to pay bills, fighting to fund the living wage, fighting to change a broken system, fighting . . . fighting . . . fighting. Sometimes I just get tired.

Here’s a date for the diary: Birmingham Care Awards, June 2, Edgbaston Cricket Ground and it’s all about a celebration of care.

Too many negatives haunt the industry and it’s a timely opportunity to lock up the nasty phantoms of 2015 and remember just how excellently most care plans are delivered.

As a nation we excel in care. By 2022, according to the Institute of Public Policy Research, we will need an army of 2.75 million extra carers, nurses, healthcare assistants, doctors and social workers to service a growing demand.

Care is big business now and for the future and we need desperately to promote just how brilliant individuals, teams and partnerships can perform in this developing workplace.

No-one these days appears to be arguing that carers should not be paid more for the invaluable work they do. The exchanges are more about where the funding will emerge to reward this valuable social asset.

As head of the West Midlands Care Association, I’ve campaigned with many others for the Government to throw a lifeline to the industry. I am aware good care saves our nation an absolute fortune.

Our media man has some great carers for his ailing wife on a direct payments arrangement. The care is so good nursing calls have been reduced form an average of 4.3 x2 visits per week, averaging eight hours of clinical time, to 1 x1 every three months for a catheter change.

Saving to the NHS in this single case are awesome. Do you know the majority of care for ill, older and disabled people is provided not by doctors, nurses or care workers but by family and friends. More people are caring for a loved one than ever before, with one in eight people providing unpaid care to loved ones. From taking a partner with an illness to hospital appointments, to helping a disabled sibling with washing and dressing, to caring full time for an elderly parent, we are, increasingly, a nation of carers.

New Carers UK figures show that this help is worth £132bn per year – more than double its value in 2001. This figure is calculated by adding up all of the care provided by carers and working out the cost of the state providing the same amount of support. And this unprecedented figure of £132bn – more than the value of HSBC Holdings, or Visa plc – does not appear to reflect nursing costs.

The outpouring of caring is indeed something to be proud of, but I’m equally appalled that such a huge burden is placed on so many without any professional, paid carers on the scene. For some, that will be a choice. For the majority, I fear, it’s because the bar is now too high for them to warrant a funded care package.

The figure is confetti money – the cost of a second NHS service. So, what is driving the increase in the value of care? Demographic change now means means that the numbers of those in need of care and support is beginning to exceed the numbers of working age family members able to provide it. But more critically is the fact that cuts to social security and local care services means people are receiving less support. It’s ticking time bomb, I fear, for surely this amount of ‘unofficial’ caring cannot be sustained indefinitely without some major support.

One wonders how long it will be before the carers crumble and their charges are, by default, neglected. I know of family carers who are struggling to make ends meet financially. Ordinary people, fighting to balance their domestic books, they are desperate for social services’ funding, but the pool of money to fund such intervention has evaporated.

Government has broken too many promises on the care issue to mention, but I will bring your attention to the hypocrisy of David Cameron. Did you know he protested about frontline cuts to public services suggested by his own Conservative local council?

A leaked letter shows Cameron chastised Ian Hudspeth, leader of Oxfordshire County Council, for considering cuts to elderly day centres and other services. ‘Not in my back yard,’ springs to mind.

A whopping £132bn . . . the yield for zero investment. It surely doesn’t take a lot of imagination to envisage more savings longterm if monies could be poured in to social care to fund a more professional approach. Goodness knows, those heroic and stoic people who care for their loved-ones out of a seemingly endless pool of compassion and love deserve it!

The cost of care is always going to be a hot potato. For a start, many people wrongly think it should always be wholly funded by local authorities and then, of course, there’s a whole load of confusion over fees.

Enter the faithful BBC with its story that families are paying too much for care in England “all too often” . . . because of confusing or incorrect information from councils.

That’s the verdict of the Local Government Ombudsman, which noted that some people were not offered an affordable care option in their area.

It said: “The decision to place a loved one in a care home can be one of the hardest any family has to make, but all too often families are paying too much for their care because they are not getting the correct, timely information.”

Thrown into the mix are top-up fees, one of the main reasons confusion exists, according to Andrew Kaye, from the charity Independent Age.

Care England says top-up fees are helping to mask a funding crisis in social care, with some of the poorest people and their families being asked to fill holes in the budgets of local authorities. I agree, but must add that this is the only way many care businesses are able to survive in these difficult times.

The moral argument will doubtless run and run, but the fact remains until such times council fees paid equal the realistic cost of care I see little changing.

In addressing the moral high ground critics, I would ask them to consider what options there would be for non-top-up residents if homes closed because such fees were not levied.

It really would not take much to push so many of our providers into an economic tailspin.

Professor Martin Green, of Care England, argues care should be available “at a cost which the local authority should be happy to pay.”

Of course that should be the case. It’s important, however, that care providers are not seen as the villain of the piece here.

Central Government with its sweeping fiscal restraint within the care sector has forced councils and the care marketplace into a dire corner, the likes which I have never seen. Mr Cameron and his cohorts clearly know of our crisis and the fact local authorities are between a rock and hard place, They could and should bring it to an end.

Jacqueline Jones is a care worker who wrote a feature in the Guardian on her 40 years in the sector. Between the colourful reflections there emerges a warm, committed woman, who is like so many carers I meet.

The article is a celebration of compassion and marks clearly the changes that have occurred.

Jacqueline has gone from care worker to social worker for Richmond council, to owner and director of a private domiciliary care company in Surrey, she founded in 1994.

Her comment that “these days I barely recognise the care industry” resonated with me.

In the early ’80s, she says “we were called home helps and we provided shopping and cleaning in two-hour blocks. We had freedom to adapt how we cared for people and build proper relationships. We had time, a luxury that care workers today don’t have and we really could be what every company now advertises itself as: part of the family.”

It’s essential that some of that home comfort caring is recaptured and there are pockets of real hope emerging in the Dudley borough through the direct payments system.

A colleague of mine has DP package for his wife who has had MS for 28 years. He employs five PAs and they have, with skillful management of funding, revolutionised the quality of life for this lady.

Talking to me the other day he said: “In a year they have become an essential extension of our family. They have supported us through two family deaths, brought a new sense of life into the home and revolutionised my wife’s outlook on life.

“The secret . . . they have built strong relationships, the care is joined up and even with holiday cover,it’s still seamless.”

In her narrative, Jacqueline refers to a “freedom” to express care in different ways. In my colleague’s case, the freedom of mapping his wife’s care has been a life-changer, with the whole family benefitting.

The package is a fantastic success story and a credit to the social worker who saw the potential, worked it through and made it happen with LST, the support agency of choice.

Community care has changed since the days Jacqueline actually took in a client’s dog when her client was admitted to hospital, but the heart that inspired actions like that still beats strong within the industry.

Looking to the future, Jacqueline says “the vicious circle of low status homecare work must be broken.”

I agree. In my colleague’s case perhaps we’re seeing some sunnier days for his wife now, in what previously had been a very long, dark winter. Let’s hope that example can be replicated.

I agree. In my colleague’s case, perhaps we’re seeing some sunnier days for his wife now in what has previously had been a very long, dark winter. Let’s hope that example can be replicated.

Found an interesting piece online with the Guardian Social Care Network all about the thorny subject of pay – the living wage to be precise.

The article notes “care work has become synonymous with poor pay, zero-hours contracts and long hours. “

But it adds there is a split in the sector in its response to pay.

Let me quote: “This surprising split within the care sector has seen 20 homecare providers out of about 5,000 become accredited living wage employers, paying the living wage of £7.85 an hour or the London living wage of £9.15 an hour, whereas there are only four care home providers out of over 8,000 in the UK similarly accredited.”

The article informs that an estimated 1,200 homecare workers are paid the living wage, while the number of care home staff receiving it is thought to be around 700.

The article rightly observes that “part of the reason some homecare providers are more willing to pay the living wage seems to be pressure from local authorities, such as Islington and Southwark, that are committed to being living wage employers.”

It’s an enlightened approach, but one that by economic definition is going to be regional. The South has more than here in the West Midlands. More wealth, more private clients, more better paid jobs . . . generally more of all the wealth generators.

According to the article, Michael Vaughan, owner and manager of Red Rocks care home on Wirral, which pays the living wage, believes councils are too scared to pressure care home providers as then they will have to pay a higher fee to those homes.

Indeed!

He claims to have seen pressure placed on homecare providers by councils to pay the living wage, but not on care home providers.

He is quoted as saying: “I think the local authorities have a major part to play in this. The large majority of care homes up and down the country rely on socially-funded clients and the wages of the staff take up half of the fee for each resident. I know care homes that receive social services funding and they would love to be able to pay the living wage.”

That’s very true. Many of the West Midlands Care Association providers have a genuine desire to reward better their staff, but the local authority fees will not sustain such a privilege.

He also thinks homecare agencies have been more forthcoming in paying the living wage because they have fewer overheads than care home providers.

Mr Vaughan has been paying the living wage to his staff for well over a decade and admits he can only do this because the large majority of residents in Red Rocks are privately funded.

As I’ve mentioned in a recent blog, charging the right fee is crucial, but the pain of reality is readily captured in comments from Ian Smith, chairman of Four Seasons, the largest care home provider in the UK.

According to the Guardian he believes it is just not financially viable for most care homes to pay care workers the living wage, and thinks it would result in closures.

I agree.

He says: “The living wage is a concept of fairness that few would argue with, but it has to be affordable and right now for many employers that just isn’t the case. Due to financial constraints in the aftermath of the international financial crisis, the fees local authorities pay for care home places have reduced by 5 per cent in real terms over three years while non-discretionary costs of wages, energy, food have risen.”

With payrolls the biggest single cost item for operators, minimum wage increases alone are challenging. Add on top of that living wage margins and there is scope for real trouble.